Higher Cancer Costs Linked to Pre-existing Psychiatric Diagnoses

Alexandra Wilson Pecci, September 27, 2017

Researchers say that new payment models in radiation oncology should also consider measures to address behavioral health.

Cancer patients with pre-existing psychiatric diagnoses had 208% higher follow-up ED costs than patients without them, according to a new study from Mayo Clinic.

Those patients also had 193% higher follow-up hospital outpatient costs and 190% higher follow-up hospital inpatient costs.

That’s why researchers say that new payment models in radiation oncology should also consider measures to address behavioral health. Doing so would reduce the total cost of care during and after radiotherapy, they assert.

Mental and behavioral health conditions are often associated with chronic conditions, from cardiovascular disease, to diabetes, to arthritis, and healthcare providers are increasingly including mental health care with their routine medical care.

"Psychiatric health is an essential component of comprehensive cancer care,” the study's lead author Mark Waddle, M.D., a radiation oncologist at Mayo Clinic's Florida campus, said in a statement. "However, little has been done to quantify the impact of pre-existing psychiatric conditions on the cost of cancer care."

The researchers examined costs for acute and follow-up for patients with and without psychiatric comorbidities who received radiation therapy at Mayo Clinic's Florida campus between 2009 and 2014.

They presented their findings at the 59th Annual Meeting of the American Society for Radiation Oncology in San Diego.

Researchers studied the cost of care for 1,275 cancer patients over five years. Of those patients, 9.9% had at least one pre-existing psychiatric diagnosis.

Researchers then collected acute and follow-up costs as all costs for these patients for zero to six months and for six to 24 months after the cancer diagnosis. They subcategorized these costs into clinic, ED, hospital inpatient, and hospital outpatient costs.

They discovered that acute and long-term costs were higher in the group with pre-existing psychiatric diagnoses.

The three largest differences in costs were follow-up ED costs, (208% higher), follow-up hospital outpatient costs (193% higher), and follow-up hospital inpatient costs (190% higher).

Although age, race, sex and treatment modalities were comparable among the groups, the psychiatric group had a higher median number of comorbidities (five versus three), as well as more respiratory cancer diagnoses than the nonpsychiatric group (31% versus 17%).

"Our study suggests that interventions to improve anxiety, depression, alcohol and drug dependence and other psychiatric comorbidities not only offers a chance to improve clinical outcomes, but also provides an opportunity to decrease costs not only for patients but for the U.S. health care system as a whole,” Waddle said.

Other research also presented at the American Society for Radiation Oncology’s Annual Meeting uncovered high rates of undiagnosed depression among cancer patients.

Those researchers examined 400 cancer patients who received treatment at the University Hospital Cancer Center in Newark, New Jersey, between 2013 and 2016, assessing depression using the Center for Epidemiologic Studies Depression Scale.

Among the 40% of patients at the center who were diagnosed with depression, three in four had not previously been told they were depressed. Female patients and disabled patients were more likely to be depressed. 

Alexandra Wilson Pecci

Alexandra Wilson Pecci is an editor for HealthLeaders Media.

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